Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians / 亚洲男科学杂志(英文版)

Urologists perform the majority of vasectomies in the United States; however, family medicine physicians (FMPs) perform up to 35%. We hypothesized that differences exist in practice patterns and outcomes between urologists and FMPs. Patients who underwent a vasectomy from 2010 to 2016 were identified. Postvasectomy semen analysis (PVSA) practices were compared between urologists and FMPs, before and after release of the 2012 AUA vasectomy guidelines. From 2010 to 2016, FMPs performed 1435 (35.1%) of all vasectomies. PVSA follow-up rates were similar between the two groups (63.4% vs 64.8%, P = 0.18). Of the patients with follow-up, the median number of PVSAs obtained was 1 (range 1-6) in both groups (P = 0.22). Following the release of guidelines, fewer urologists obtained multiple PVSAs (69.8% vs 28.9% pre- and post-2012, P < 0.01). FMPs had a significant but lesser change in the use of multiple PVSAs (47.5% vs 38.4%, P < 0.01). Both groups made appropriate changes in the timing of the first PVSA, but FMPs continued to obtain PVSAs before 8 weeks (15.0% vs 6.5%, P < 0.01). FMPs had a higher rate of positive results in PVSAs obtained after 8 weeks, the earliest recommended by the AUA guidelines (4.1% vs 1.3%, P < 0.01). Significant differences in PVSA utilization between FMPs and urologists were identified and were impacted by the release of AUA guidelines in 2012. In summary, FMPs obtained multiple PVSAs more frequently and continued to obtain PVSAs prior to the 8-week recommendation, suggesting less penetration of AUA guidelines to nonurology specialties. Furthermore, FMPs had more positive results on PVSAs obtained within the recommended window.

Vasectomía: nuestra experiencia / Vasectomy: our experience

Objetivo: Describir la experiencia de 6 años en la realización de vasectomías en el sector de Cirugía Menor Ambulatoria del Hospital Público Materno Infantil de Salta. Materiales y métodos: Estudio retrospectivo, descriptivo y cualitativo. Se analizaron las estadísticas de vasectomía desde julio de 2010 a abril de 2016, considerándose datos socioeconómicos. Resultados: Se efectuaron 187 vasectomías con técnica tradicional. El promedio de edad de hombres que se sometieron a vasectomía fue de 34,6 años. El preservativo fue el método anticonceptivo más utilizado previo a la realización de la vasectomía. La edad promedio de inicio de las relaciones sexuales fue de 16,4 años. La mayoría tenía hijos al momento de la vasectomía y se sintió muy satisfecho con los resultados. Conclusión: Consideramos la vasectomía un procedimiento seguro, efectivo y de baja morbilidad, pero que requiere seguir un protocolo(AU)

Objective: To describe the experience achieved after 6 years performing vasectomies in the Minor Ambulatory Surgery sector of the Hospital Público Materno Infantil de Salta. Materials and methods: Retrospective, descriptive and qualitative study. Vasectomy statistics were analyzed from July 2010 to April 2016 considering socioeconomic data. Results: 187 traditional vasectomies were performed. The average age of men who had vasectomy was 34.6. The condom was the most used contraceptive method before they had a vasectomy. The average age of onset of sexual intercourse was 16.4 years. Most had children at the time of vasectomy and felt very satisfied with the results. Conclusion: We consider vasectomy a safe, effective and of low morbidity procedure, though it requires to follow a protocol(AU)

Unilateral absence of vas deferens: prevalence among 23, 013 men seeking vasectomy

ABSTRACT Purpose: To determine the prevalence of unilateral absence of vas deferens (UAVD) in men with both testes seeking vasectomy. Materials and Methods: Computerized charts of 23,013 patients encountered between January 1994 and December 2013 in one university hospital and two community clinics of Quebec City, Canada, were searched. Pre-vasectomy consultation, operative reports and semen analysis results were reviewed to identify cases of UAVD. Cases were categorized as confirmed (unilateral vasectomy and success confirmed by semen analysis) or possible congenital UAVD further sub-categorized according to whether or not a scrotal anomaly was present. Results: Among 159 men identified as potentially having UAVD, chart review revealed that 47 had only one testicle, 26 had bilateral vasa, and four were misdiagnosed (post-vasectomy semen analysis [PVSA] showing motile sperm after unilateral vasectomy) leaving 82 men deemed cases of UAVD (0.36%, 95% confidence interval 0.28% to 0.43%). These were classified as confirmed (n=48, 0.21%) and possible (n=34, 0.15%; 22 without and 12 with scrotal anomalies) congenital UAVD. The misdiagnosis ratio of UAVD was low when scrotal content was otherwise normal (1:48), but higher if anomalies were present (3:12). Conclusions: Most surgeons who perform vasectomy will encounter cases of UAVD. In most suspected cases, it is safe and effective to proceed with unilateral vasectomy under local anesthesia while stressing the need for PVSA. Further studies or scrotal exploration may be considered in patient with prior scrotal surgery.

Atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas, São Paulo, Brasil: percepção de gestores e profissionais dos serviços públicos de saúde / Provision of voluntary surgical sterilization in the Campinas Metropolitan Area, São Paulo State, Brazil: perceptions of public health services managers and professionals

A presente pesquisa descreve a percepção de gestores e profissionais de serviços públicos de saúde de municípios da Região Metropolitana de Campinas, São Paulo, Brasil, acerca do atendimento à demanda pela esterilização cirúrgica voluntária. Trata-se de estudo qualitativo, em quatro municípios, onde se realizaram entrevistas semi-estruturadas com 26 gestores e profissionais de saúde envolvidos no atendimento às solicitações de esterilização cirúrgica. Apontaram-se dificuldades para agendamento de consultas nos ambulatórios de planejamento familiar ou centros de referência e número insuficiente de cirurgias que podiam ser agendadas semanalmente nos hospitais credenciados. Enfatizou-se a falta de estrutura física e recursos humanos tanto nas unidades básicas de saúde, quanto nos ambulatórios de planejamento familiar ou centros de referência. Houve críticas aos critérios legais para autorizar a esterilização, bem como se mencionaram adaptações para torná-los mais adequados à situação de cada município. Gestores e profissionais de saúde entendiam que, apesar dos esforços empenhados, o atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas estava prejudicado pela centralização em ambulatórios de planejamento familiar ou centros de referência, que, na prática, tinham que suprir as deficiências da oferta de ações de planejamento familiar em geral na rede básica de cada município.

This study describes the perceptions of public health services managers and professionals concerning provision of voluntary surgical sterilization in the Campinas Metropolitan Area, São Paulo State, Brazil. The study adopted a qualitative approach in four municipalities (counties), where semi-structured interviews were conducted with 26 health professionals and health services managers involved in the provision of surgical sterilization. The interviewees identified difficulties in scheduling visits at Outpatient Family Clinics or Reference Centers (APF/CR), and the number of available surgeries in the accredited hospitals was insufficient. They emphasized the lack of physical infrastructure and human resources for conducting family planning activities in the primary health units as well as in the APF/CR.They also criticized the legal criteria for authorizing surgical sterilization, and mentioned adaptations to make them more appropriate to the each municipality's situation. According to the health services managers and professionals, despite the efforts, meeting the demand for surgical sterilization in the Campinas Metropolitan Area was jeopardized by its centralization in the APF/CR, which in practice had to cover the gap in family planning activities in each municipality's primary care units.

Características dos candidatos à esterilização cirúrgica e os fatores associados ao tipo de procedimento / Characteristics of candidates for surgical sterilization and factors associated with type of procedure

Em 1999, a Secretaria Municipal de Ribeirão Preto, São Paulo, Brasil, implantou a oferta de métodos de esterilização cirúrgicos, de acordo com a legislação vigente. Este estudo objetivou caracterizar os candidatos à esterilização cirúrgica e estudar as variáveis associadas ao tipo de procedimento. Foram pesquisados 95 prontuários de candidatos e realizada análise estatística por meio de regressão logística e do teste exato de Fisher, considerando-se o nível de significância de p = 0,05. A maioria dos candidatos são casais estáveis, de baixa escolaridade e baixa renda, satisfeitos com o número de filhos e que já haviam tentado limitar a prole com o uso de anticoncepcionais reversíveis. A média de idade era de 34,2 anos; 45,3 por cento se submeteram à esterilização feminina; 35,8 por cento, à vasectomia, e 18,9 por cento não obtiveram o procedimento. A chance de o homem, com 35 anos ou mais, fazer vasectomia é 6,1 vezes a do homem mais jovem (OR = 6,1; IC95 por cento: 2,4-16,4); submetem-se à vasectomia mais homens casados do que os que coabitam (OR = 4,0; IC95 por cento: 1,5-12,4) e mulheres com quatro filhos ou mais fazem mais laqueadura do que aquelas com menos de quatro filhos (OR = 3,1; IC95 por cento: 1,1-8,5).

Fertlidad inmediata post vasectomía / Immediate fertility post vasectomy

La vasectomía es una técnica simple y eficiente en el objetivo de controlar la natalidad por medios quirúrgicos en el varón. Nosotros estudiamos a pacientes fértiles que deseaban ser sometidos a esta técnica con el fin de regular su natalidad en forma definitiva. Los espermiogramas post operatorios a la semana, dos semanas y al mes, demostraron presencia de espermios pero de escasa motilidad con lo cual concluimos que el efecto esterilizador de la vasectomía es inmediato, independientemente del número de espermios encontrados.

Experiencia del programa "Vasectomía sin bisturi" en una unidad de primer nivel de atención / The no-scalpel vasectomy in a primary-care center

Objetivo: Analizar la experiencia del programa "vasectomía sin bisturi" (VSB) en una unidad de atención primaria. Diseño: estudio descriptivo, observacional con seguimiento de pacientes. Emplazamiento: Centro de Salud de Atención Primaria "Dr. José Castro Villagrana", Secretaría de Salud, México. Pacientes: Trescientos setenta y un expedientes de pacientes a quienes se realizó VSB entre 1993 y 1995, con seguimiento posvasectomía por 24 meses (1995-1997). Mediciones y resultados: Se analizaron variables socioeconómicas, consejería y consentimiento informado, estudio clínico, motivos por los que se eligió la vasectomía como método definitivo de control de la natalidad, estudios de laboratorio, nota del acto quirúrgico, complicaciones y evolución postquirúrgica (cuenta de espermatozoides). La edad promedio de los pacientes fue de 33 ñ 7 años con rango de 19 a 69, escolaridad de nueve años, el 82.5 por ciento eran casados con promedio de dos hijos. La tasa de complicaciones como hematomas en el escroto fue del 1 por ciento y epididimitis de 3.9 por ciento; los hombres manifestaron dolor local uno a dos días, integrándose posteriormente a sus actividades habituales. El tiempo promedio para que la cuenta de espermatozoides resultara negativa fue de cinco meses. El 22 por ciento (81) de los pacientes iniciaron sus relaciones sexuales antes de 10 días a la VSB y el 34 por ciento antes de los 20 días. Conclusiones: El consejo y el consentimiento informado son elementos esenciales para el desarrollo del Programa "Vasectomía sin bisturí" y para la participación activa del varón en la planificación familiar

Relación entre el nivel de conocimientos y actitudes de los docentes varones de la Facultad de Medicina de la UNSA sobre la vasectomía, 1997

OBJETIVOS: Determinar el nivel de conocimientos que tienen los docentes varones de la Facultad de Medicina de la UNSA sobre vasectomía. Determinar las actitudes de los docentes varones de la Facultad de Medicina de la UNSA respecto a la vasectomía. Establecer la relación que existe entre los conocimientos y las actitudes de los docentes varones de la Facultad de Medicina de la UNSA acerca de la vasectomía. TIPO DE ESTUDIO: Observacional y analítico. MATERIAL Y METODOS: Se evaluó a 105 docentes de la Facultad de Medicina de la UNSA, a través de una ficha-encuesta, los conocimientos (bueno, aceptable, deficiente) y actitudes (acuerdo, incertidumbre, desacuerdo) respecto a la vasectomía representando una tasa de respuesta de 88.98 por ciento. CONCLUSIONES: La mayoría de los docentes varones de la Facultad de Medicina de la UNSA (71.44 por ciento) tiene un aceptable nivel de conocimientos sobre la vasectomía. En la misma población hay una actitud favorable hacia la vasectomía en el 85.71 por ciento. Existe una correlación directa entre su nivel de conocimientos y sus actitudes sobre vasectomía (p<0.001).

Promotion of vasectomy in Thailand.

Though vasectomy plays an important great role in the national family planning program, its popularity has been very low in the past requiring a lot of promotion. During the promotion phase of 1972 to 1984, various methods were used with the stress on mobile vasectomy campaign. However, after 1984, there was evidence of deceleration of vasectomy rate. In this phase, non-scalpel vasectomy has been promoted including the training courses for physicians in provincial hospitals and local health centers. It is expected that vasectomy will gain better acceptance in the future.

Vasectomía parcial bilateral / Partial bilateral vasectomy

La vasectomía es un procedimiento quirúrgico que tiene como propósito la obstrucción de los conductos deferentes en el varón. Su empleo está muy difundido en los países asiáticos, principalmente en la India y la República Popular China, en algunos países de Europa y en los Estados Unidos de Norteamérica. Está indicada como método de planificación familiar en casos de multiparidad, riesgo reproductivo elevado y riesgo de alteraciones congénitas. La selección de los candidatos debe considerarse como una firme decisión basada en información completa y adecuada sobre la naturaleza, los beneficios y los riesgos del procedimiento. La técnica quirúrgica consiste en la sección y obstrucción de los conductos deferentes a nivel de la parte alta del escroto, utilizando anestesia local con lidocaina al 1 ó 2 por ciento. La función endocrina del eje del hipotálamo, hipófisis y testículo no se modifica ni se presentan alteraciones inmunológicas, metabólicas o de la esfera sexual